Up to 50% of patients fail to acquire usable esophageal speech following laryngectomy. Causes for failure include many preventable and correctable anatomical and psychological conditions as well as social and motivational problems for which a remedy is less certain. Comprehensive rehabilitation addresses all these factors but its effectiveness and costs are not known. The value of a comprehensive rehabilitation program will be determined from the successes of 100 new laryngectomees who will be carefully evaluated before, during and after therapy and compared with 100 retrospective control laryngectomees whose rehabilitation was not part of this study. Analyses of factors correlating with success or failure will be made. Cost effectiveness will be determined.